Experience of nurses with using eHealth in Gilgit-Baltistan, Pakistan: a qualitative study in primary and secondary healthcare

Background: To improve the quality of health care in remote parts of Pakistan, a research project was initiated in the mountainous region of Gilgit-Baltistan using information and communication technology to improve patient care and support continuing education of health providers (eHealth). This paper describes the experience of nurses in using eHealth in their routine practices. Methods: All health centres of Gilgit-Baltistan, Pakistan using eHealth as part of this study, were taken as a single case. These include four primary healthcare centres, three secondary care centres and one medical centre. In-depth interviews were conducted using semi-structured interview guide to study nurses’ perspective about using eHealth, and its perceived impact on their professional lives. Results: According to the respondents, eHealth enhanced access to care for remote communities, and improved quality of health services by providing opportunities for continuing learning. Nurses also appreciated eHealth for reducing their professional isolation, and providing exposure to new knowledge through teleconsultations and eLearning. The responses categorized under six major headings include: gaps in health services prior to eHealth; role of eHealth in addressing these gaps; benefits of eHealth; challenges in eHealth implementation; community’s perception about eHealth; and future recommendations. Conclusions: Low-cost and simple eHealth solutions have shown to benefit nurses, and the communities in the remote mountainous regions of Pakistan

Are we empowered? A qualitative approach to unfold the experiences of female nurses in Pakistan

The disparity of men and women in certain societies, such as Pakistan, is a growing concern. The disparity, unchanging mind-set, and definitions rooted in traditions do not free individuals from the socially bound gender identities. In such circumstances, educational institutions can become a way of transforming social structures. Considering female nurses in Pakistan as a case study, this paper explores the notion of “empowerment” and the factors responsible for empowerment or disempowerment of female nurses. The study also evaluates the role of a leading nursing institution in Pakistan namely the Aga Khan University- School of Nursing and Midwifery (AKUSONAM) in empowering female nurses. The data is collected through five focus group discussion among forty-five alumni of AKU-SONAM. The findings of the study presents an “inside-out” understanding of the term “empowerment” by female nurses of Pakistan and; enlists the challenges faced by women in Pakistan in becoming and working as nurses. The study also put forward recommendations for nursing professional bodies such as Pakistan Nursing Council and Pakistan Nursing Federation and other nursing institutions in Pakistan. The paper would serve as a guide to enhance further development in nursing and women empowerment

Barriers in adopting blended learning in a private university of Pakistan and East Africa: Faculty members’ perspective

Background: Education methods have undergone transformation over the centuries. Use of technology is the cornerstone for innovation in teaching methods. Hence, blended learning which includes face to face and online modalities is being increasingly explored as effective method for learning. This pilot study determines the perceptions of faculty members in a private international university on barriers influencing adoption of technology for teaching and learning. Methods: A cross-sectional survey was conducted through a self-reported questionnaire using ‘survey monkey’. The data was entered and analyzed using Statistical Package for the Social Sciences (SPSS version 20). Frequencies and proportions are reported. Results: Findings indicated that 51.6% faculty members perceived the importance of integration of technology in their teaching. Around 54% of the participants recognized that they do possess the ability and accessibility to integrate information communication technology (ICT) in teaching and learning, but there is a need to hone the basic information technology (IT) skills to initiate technology driven teaching. Findings revealed that 55% faculty members acknowledged the constraint of not getting protective time to develop and deliver technology driven courses. Further, results showed that 45% faculty members perceived that their innovation efforts in terms of teaching as blended learning do not count towards their professional promotion or recognition, as usually priority is given to research over teaching innovation. The findings also indicated that 54.5% participants asserted that university lack mentorship in the field of blended learning. Conclusions: Therefore, study suggests that universities should provide adequate mentorship programmes for the faculty members in enhancing their skills of integrating technology in their teaching

Need for multilevel strategies and enhanced acceptance of contraceptive use in order to combat the spread of HIV/AIDS in a Muslim society: a qualitative study of young adults in urban Karachi, Pakistan.

This qualitative study explored knowledge, attitudes, beliefs and perceptions of sexual and reproductive health, focusing specifically on contraceptive use and HIV prevention among young unmarried men and women, 17-21 years, in urban Karachi, Pakistan. The main theme, identified as underlying meaning in the focus group discussions was Societal norms and perceptions create barriers to knowledge and awareness about sexual and reproductive health matters among young adults . A knowledge gap was revealed concerning HIV/AIDS and contraceptive use among young males and females, who have to rely on media and peers for information seeking. Study participants perceived that HIV/AIDS is incurable and carries a social stigma. It was further revealed, that there is an opposition towards contraceptive use from religious leaders. Young adults in Pakistan are in need of improved knowledge about HIV/AIDS and contraceptive use. Youth clinics and schools/colleges may play a significant role in this regard. The religious leaders need to be informed about the beneficial effects of contraceptives and they should be part of any family planning/contraceptive use program to ensure better community acceptance. At the structural level there is an urgent need for policies targeting the issue of sexual and reproductive health, particularly HIV/AIDS information and contraceptive use to target the young population. The health care services should be able to respond by offering relevant services

Factors associated with stress among adolescents in the city of Nawabshah, Pakistan.

OBJECTIVE: To identify the risk factors of stress among school-going adolescents in rural Nawabshah, Pakistan. METHODS: The cross-sectional study was conducted in 2005, comprising 800 school-going children of 10-16 years of age in Nawabshah, through simple random sampling. Data was collected using a structured questionnaire to assess the potential risk factors of stress. A modified version of Perceived stress scale was utilized to measure stress level. SPSS 12 was used for statistical analysis, while multiple linear regression analysis was run to identify the factors associated with stress in the study population. RESULTS: Of the total, 529 (66%) children belonged to state-run schools while 271 (34%) were studying at private facilities. The mean age was 13.7+/-1.3 years. The level of stress was positively associated with the number of siblings, parental conflicts, the age of the mother and the number of rooms in the household. There was decreased level of stress among female adolescents (n=474; 59.3%) who had prior information about pubertal body changes than the boys (n=326; 40.8%). CONCLUSION: The study showed that stress among adolescents can be reduced by modifying socio-economic and demographic factors

Does empowerment matter? Perceptions of nursing leaders in Pakistan through qualitative approach.

Background: In a patriarchal society like Pakistan, where women are oppressed, women dominating professions like nursing is mostly seen as disempowered and requires considerable struggle to achieve its due recognition and respect. Aim: This study aims to explore the experiences of empowerment among the nursing leaders of Pakistan. Methods: This study uses a qualitative descriptive design. Total of twelve Pakistani Nursing leaders were interviewed using semi-structured interview guideline to explore their experiences of empowerment. Results: The study findings revealed five major categories which include: status of a nurse, nursing profession, power relationships, value-belief system, and leadership and management. Conclusions: Nurses’ empowerment is essential for enhancing the image and status of nursing profession in Pakistan. The study identified various personal and professional factors affecting nurses’ empowerment in the country and suggests various strategies, such as access to higher nursing education, development of enhanced nursing leadership competencies and understanding of power and politics of the organization, through which nurses can achieve empowerment

Validity and reliability testing: Urdu translated modified Response to Symptoms Questionnaire.

OBJECTIVE: To determine validity and reliability of the Urdu translated, modified Response to symptoms questionnaire (RSQ) among acute coronary syndrome (ACS) patients in Karachi. STUDY DESIGN: A qualitative, tool validation study. PLACE AND DURATION OF STUDY: Two tertiary care hospitals in Karachi, the Aga Khan University Hospital, Karachi and the Karachi Institute of Heart Diseases, from December 2010 to April 2011. METHODOLOGY: After making certain modifications, the original tool in English was translated into Urdu. Next, five cardiology experts evaluated the tool for its content and face validity. Test retest and inter rater reliabilities were computed for the RSQ using 5% of the total sample size of the parent study. RESULTS: Sufficient conceptual and semantic equivalence was found between the Urdu and English versions of the modified RSQ. Content validity index was calculated to be 1 for both relevance and linguistic clarity. Test retest and inter rater reliabilities were calculated to be 95.9% and K = 0.97, respectively. CONCLUSION: The Urdu translated modified RSQ has sufficiently acceptable content validity, test retest and inter rater reliability; hence, it should be used by the researchers for the evaluation of factors associated with pre-hospital delay among Urdu speaking ACS patient populations

The intersection of school corporal punishment and associated factors: Baseline results from a randomized controlled trial in Pakistan

Violence against youth is a global issue; one form of youth victimization is school corporal punishment. We use baseline assessments from a cluster randomized controlled trial to examine the prevalence of school corporal punishment, by gender, and the relationship to levels of peer violence at school, parent corporal punishment, youth food security and youth academic performance and school attendance in Pakistan. Forty homogenous public schools in the urban city of Hyderabad, Pakistan were chosen for randomization into the trial evaluating a youth violence prevention intervention. 1752 6th graders, age 11-14 years, were selected as the target population. Since schools are segregated by gender in Pakistan, data are from interviews in 20 boys\u27 schools and 20 girls\u27 schools. Overall, 91.4% of boys and 60.9% of girls reported corporal punishment at school in the previous 4 weeks and 60.3% of boys had been physically punished at home in the past 4 weeks compared to 37.1% of girls. Structural equation modeling revealed one direct pathway for both boys and girls from food insecurity to corporalpunishment at school while indirect pathways were mediated by depression, the number of days missed from school and school performance and for boys also by engagement in peer violence. Exposure to corporal punishment in school and from parents differs by gender, but in both boys and girls poverty in the form of food insecurity was an important risk factor, with the result that poorer children are victimized more by adults

Preventing peer violence against children: methods and baseline data of a cluster randomized controlled trial in Pakistan.

BACKGROUND: Violence against and among children is a global public health problem that annually affects 50% of youth worldwide with major impacts on child development, education, and health including increased probability of major causes of morbidity and mortality in adulthood. It is also associated with the experience of and perpetration of later violence against women. The aim of this article is to describe the intervention, study design, methods, and baseline findings of a cluster randomized controlled trial underway in Pakistan to evaluate a school-based play intervention aiming to reduce peer violence and enhance mental health. METHODS: A cluster randomized controlled design is being conducted with boys and girls in grade 6 in 40 schools in Hyderabad, Pakistan, over a period of 2 years. The Multidimensional Peer-Victimization and Peer Perpetration Scales and the Children\u27s Depression Inventory 2 (CDI 2) are being used to measure the primary outcomes while investigator-derived scales are being used to assess domestic violence within the family. Specifics of the intervention, field logistics, ethical, and fidelity management issues employed to test the program\u27s impact on school age youth in a volatile and politically unstable country form this report. BASELINE RESULTS: A total of 1,752 school-age youth were enrolled and interviewed at baseline. Over the preceding 4 weeks, 94% of the boys and 85% of the girls reported 1 or more occurrences of victimization, and 85% of the boys and 66% of the girls reported 1 or more acts of perpetration. Boys reported more depression compared with girls, as well as higher negative mood and self-esteem scores and more interpersonal and emotional problems. INTERPRETATION: Globally, prevalence of youth violence perpetration and victimization is high and associated with poor physical and emotional health. Applying a randomized controlled design to evaluate a peer violence prevention program built on a firm infrastructure and that is ready for scale-up and sustainability will make an important contribution to identifying evidence-informed interventions that can reduce youth victimization and perpetration